Determinants of Diabetes Disease Management, 2011–2019
Abstract
:1. Introduction
2. Materials and Methods
2.1. Data and Software
2.2. Dependent Variables
- About how often do you check your blood for glucose or sugar? (BLDSUGAR).
- About how many times in the past 12 months have you seen a doctor, nurse, or other health professional for your diabetes? (DOCTDIAB).
- About how many times in the past 12 months has a health professional checked your feet for any sores or irritations? (FEETCHK).
- About how many times in the past 12 months has a doctor, nurse, or other health professional checked you for A1C? (CKHEMO3).
- Have you ever taken a course or class in how to manage your diabetes yourself? (DIABEDU).
- When was the last time you had an eye exam in which the pupils were dilated, making you temporarily sensitive to bright light? (EYEEXAM1).
2.3. Independent Variables
2.3.1. Demographics
2.3.2. Socioeconomic Status
2.3.3. Health Status
2.4. Medicaid Expansion Linear Splines
2.5. Missing Data
2.6. Inferential Methods
3. Results
3.1. Descriptive Statistics
3.1.1. Dependent Variables
3.1.2. Demographics
3.1.3. Socioeconomic Status
3.1.4. Health Status
3.2. Inferential Statistics
3.2.1. Effect Sizes
3.2.2. Demographic Analysis
3.2.3. Socioeconomic Status
3.2.4. Health Status
3.2.5. Medicaid Expansion
3.2.6. Sub-Model Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Type | # of Factor Levels | Unknown | % Unknown | |
---|---|---|---|---|
Age | Categorical | 3 | - | 0.00% |
Race | Categorical | 6 | 9701 | 1.90% |
Gender | Categorical | 3 | 207 | 0.04% |
Marital Status | Categorical | 7 | 2612 | 0.51% |
Income | Categorical | 9 | 88,018 | 17.22% |
Education | Categorical | 6 | 2169 | 0.42% |
Work Status | Categorical | 9 | 3704 | 0.72% |
Health Plan | Categorical | 3 | 1452 | 0.28% |
Personal Doctor | Categorical | 3 | 1826 | 0.36% |
Annual Checkup | Categorical | 3 | 8075 | 1.58% |
Cost Affected Care | Categorical | 3 | 1890 | 0.37% |
Health Status | Categorical | 6 | 2252 | 0.44% |
Medicaid Expansion | Quantitative | N/A | - | 0.00% |
HbA1c | Bld. Sugar | Diab. Ed. | Dr. Visit | Eye Exam | Ft. Check | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Intercept | 26.418 | *** | 4.808 | *** | 1.915 | *** | 6.731 | *** | 3.135 | *** | 3.055 | *** |
Age 55–64 | 1.015 | 0.998 | 0.985 | 0.986 | 1.190 | *** | 1.072 | * | ||||
Age 65+ | 0.623 | *** | 1.001 | 0.805 | *** | 1.000 | 1.704 | *** | 0.992 | |||
Male | 0.846 | *** | 0.961 | 0.820 | *** | 0.991 | 0.932 | *** | 1.128 | *** | ||
Black | 0.731 | *** | 1.283 | *** | 1.205 | *** | 1.021 | 1.337 | *** | 1.375 | *** | |
Hispanic | 0.638 | *** | 0.968 | 0.802 | *** | 0.961 | 1.103 | * | 0.736 | *** | ||
Other | 0.709 | *** | 0.899 | 0.776 | *** | 0.912 | 1.314 | *** | 1.024 | |||
Multirace | 0.736 | ** | 1.060 | 1.149 | * | 1.214 | * | 0.936 | 0.995 | |||
Unk. Race | 0.660 | *** | 0.995 | 0.938 | 0.985 | 0.991 | 0.961 | |||||
Divorced | 0.769 | *** | 0.719 | *** | 0.940 | * | 0.929 | + | 0.869 | *** | 0.845 | *** |
Widowed | 0.662 | *** | 0.790 | *** | 0.821 | *** | 1.036 | 0.896 | *** | 0.844 | *** | |
Separated | 0.716 | *** | 0.740 | *** | 0.872 | * | 1.083 | 0.764 | *** | 0.894 | + | |
Nvr. Married | 0.711 | *** | 0.692 | *** | 0.899 | ** | 0.987 | 1.016 | 0.895 | ** | ||
Unm. Couple | 0.840 | 0.880 | 0.979 | 0.977 | 0.835 | * | 0.859 | + | ||||
Unk. Relationship | 0.974 | 0.695 | * | 0.964 | 1.211 | 0.900 | 0.802 | |||||
<$10 K | 0.466 | *** | 1.123 | 0.709 | *** | 1.047 | 0.712 | *** | 0.839 | ** | ||
<$15 K | 0.571 | *** | 1.162 | * | 0.784 | *** | 1.055 | 0.707 | *** | 0.952 | ||
<$20 K | 0.579 | *** | 1.323 | *** | 0.830 | *** | 1.026 | 0.703 | *** | 0.986 | ||
<$25 K | 0.588 | *** | 1.241 | *** | 0.849 | *** | 1.046 | 0.712 | *** | 0.950 | ||
<$30 K | 0.643 | *** | 1.174 | ** | 0.902 | ** | 1.017 | 0.803 | *** | 0.939 | ||
<$50 K | 0.744 | *** | 1.061 | 0.939 | + | 1.054 | 0.789 | *** | 0.943 | |||
<$75 K | 0.845 | * | 1.077 | 0.945 | 1.057 | 0.919 | * | 0.969 | ||||
Unk. $ | 0.393 | *** | 1.018 | 0.765 | *** | 1.040 | 0.762 | *** | 0.739 | *** | ||
1th–8th | 0.284 | *** | 0.970 | 0.415 | *** | 1.016 | 0.685 | *** | 0.718 | *** | ||
9th–12th | 0.377 | *** | 0.992 | 0.507 | *** | 0.992 | 0.633 | *** | 0.702 | *** | ||
12th | 0.586 | *** | 1.148 | *** | 0.711 | *** | 0.982 | 0.807 | *** | 0.889 | *** | |
1–3 College | 0.864 | *** | 1.060 | + | 1.027 | 0.946 | 0.872 | *** | 1.036 | |||
Unk. Ed. | 0.329 | *** | 1.413 | + | 0.577 | *** | 0.861 | 0.637 | ** | 0.512 | *** | |
Self-Employed | 1.046 | 1.070 | 0.885 | ** | 1.059 | 0.872 | ** | 0.884 | * | |||
No Work 1 yr.+ | 1.008 | 1.064 | 0.956 | 1.096 | 1.023 | 0.864 | * | |||||
No Work <1 yr. | 1.204 | + | 1.279 | * | 1.124 | 0.940 | 1.036 | 1.066 | ||||
Homemaker | 0.962 | 0.983 | 0.959 | 0.894 | 0.978 | 0.929 | ||||||
Student | 1.293 | 1.051 | 1.070 | 1.060 | 1.084 | 1.020 | ||||||
Retired | 1.058 | 1.154 | *** | 1.195 | *** | 0.964 | 1.240 | *** | 1.118 | *** | ||
Cannot Work | 0.958 | 1.295 | *** | 1.158 | *** | 0.969 | 1.151 | *** | 1.156 | *** | ||
Unk. Work | 0.913 | 0.798 | 1.077 | 0.875 | 1.061 | 1.074 | ||||||
Very Good | 1.220 | * | 1.036 | 1.044 | 0.946 | 0.977 | 1.111 | |||||
Good | 1.343 | *** | 1.290 | *** | 1.067 | 0.957 | 0.929 | 1.199 | ** | |||
Fair | 1.305 | ** | 1.416 | *** | 1.086 | 0.941 | 0.877 | * | 1.218 | ** | ||
Poor | 1.124 | 1.608 | *** | 1.125 | + | 0.913 | 0.827 | ** | 1.145 | * | ||
Unk. Health | 0.542 | *** | 0.836 | 1.074 | 0.936 | 0.672 | * | 0.509 | *** | |||
No Hlth Plan | 0.663 | *** | 0.784 | *** | 0.915 | * | 1.013 | 0.625 | *** | 0.828 | *** | |
Unk. Hlth Plan | 0.479 | *** | 0.757 | 0.644 | ** | 1.231 | 1.075 | 0.932 | ||||
No Doctor | 0.484 | *** | 0.646 | *** | 0.818 | *** | 0.927 | 0.770 | *** | 0.588 | *** | |
Unk. Doctor | 0.512 | *** | 0.760 | + | 0.796 | 1.160 | 0.632 | ** | 0.677 | * | ||
No Checkup | 0.369 | *** | 0.662 | *** | 0.895 | ** | 0.956 | 0.478 | *** | 0.463 | *** | |
Unk. Checkup | 0.434 | *** | 0.538 | *** | 0.705 | *** | 1.145 | 0.626 | *** | 0.470 | *** | |
Cost Affected | 0.831 | *** | 0.862 | *** | 1.013 | 0.924 | 0.719 | *** | 0.760 | *** | ||
Unk. Cost | 0.559 | *** | 0.816 | 0.885 | 1.345 | 1.033 | 0.564 | ** | ||||
Medicaid Expansion | 1.048 | *** | 0.971 | *** | 0.996 | 0.991 | 1.005 | 1.021 | *** |
Variable | Effect Size |
---|---|
Blood Sugar | 0.020 |
Doctor Visits | 0.001 |
HbA1c Checks | 0.125 |
Feet Checks | 0.042 |
Diabetes Education | 0.033 |
Eye Checks | 0.054 |
Group | Blood Sugar | Doctor Visit | HbA1c Checks | Feet Checks | Education | Eye Exam |
---|---|---|---|---|---|---|
Demographics | 158,197 | 161,170 | 171,814 | 226,600 | 269,802 | 237,409 |
SES | 158,199 | 161,273 | 164,780 | 225,991 | 265,841 | 237,076 |
Health | 156,833 | 161,142 | 169,671 | 223,338 | 271,800 | 234,101 |
Medicaid Expansion | 158,731 | 161,096 | 178,049 | 229,191 | 272,790 | 242,692 |
Demographics + SES | 157,615 | 161,337 | 162,816 | 224,604 | 264,410 | 234,478 |
SES + Health | 156,547 | 161,318 | 158,972 | 221,271 | 265,570 | 231,622 |
Demographics + Health | 156,390 | 161,222 | 163,559 | 221,366 | 269,090 | 231,463 |
Demographics + Medicaid Expansion | 158,148 | 161,172 | 171,410 | 226,472 | 269,799 | 237,341 |
SES + Medicaid Expansion | 158,143 | 161,274 | 164,568 | 225,918 | 265,843 | 237,056 |
Health + Medicaid Expansion | 156,752 | 161,165 | 167,452 | 223,195 | 271,241 | 232,153 |
Demographics + SES + Health | 156,045 | 161,386 | 156,825 | 220,074 | 264,184 | 230,006 |
Demographics + SES + Medicaid Expansion | 157,576 | 161,338 | 162,594 | 224,520 | 264,415 | 234,461 |
Demographics + Health + Medicaid Expansion | 156,322 | 161,222 | 163,315 | 221,311 | 269,094 | 231,455 |
SES + Health + Medicaid Expansion | 156,466 | 161,318 | 158,839 | 221,241 | 265,571 | 231,626 |
Full Model | 155,986 | 161,387 | 156,684 | 220,033 | 264,189 | 230,010 |
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Fulton, L.V.; Adepoju, O.E.; Dolezel, D.; Ekin, T.; Gibbs, D.; Hewitt, B.; McLeod, A.; Liaw, W.; Lieneck, C.; Ramamonjiarivelo, Z.; et al. Determinants of Diabetes Disease Management, 2011–2019. Healthcare 2021, 9, 944. https://doi.org/10.3390/healthcare9080944
Fulton LV, Adepoju OE, Dolezel D, Ekin T, Gibbs D, Hewitt B, McLeod A, Liaw W, Lieneck C, Ramamonjiarivelo Z, et al. Determinants of Diabetes Disease Management, 2011–2019. Healthcare. 2021; 9(8):944. https://doi.org/10.3390/healthcare9080944
Chicago/Turabian StyleFulton, Lawrence V., Omolola E. Adepoju, Diane Dolezel, Tahir Ekin, David Gibbs, Barbara Hewitt, Alexander McLeod, Winston Liaw, Cristian Lieneck, Zo Ramamonjiarivelo, and et al. 2021. "Determinants of Diabetes Disease Management, 2011–2019" Healthcare 9, no. 8: 944. https://doi.org/10.3390/healthcare9080944